CN110099715A

CN110099715A - Wireless communication between multiple implanted equipment

Info

Publication number: CN110099715A
Application number: CN201780080177.9A
Authority: CN
Inventors: 布兰登·厄尔利·库普; 威廉姆·J·林德; 基思·R·迈莱; 保罗·荷斯康; 兰斯·埃里克·朱费尔; 雅各布·M·路德维格
Original assignee: Cardiac Pacemakers Inc
Current assignee: Cardiac Pacemakers Inc
Priority date: 2016-12-23
Filing date: 2017-12-22
Publication date: 2019-08-06
Also published as: EP3558452A2; WO2018119434A3; EP3558452B1; US20180178022A1; WO2018119434A2

Abstract

Implantable medical device (IMD) such as, but not limited to leadless cardiac pacemaker (LCP), nerve stimulator (NS) and/or implantable monitor (IM) can be configured as to be communicated using more than one communication pattern and/or more than one communication vector.In some cases, implantable medical device can be configured as switches between communication pattern, vector and/or communication path, this can help to improve the communication reliability and/or communication speed between equipment.

Description

Wireless communication between multiple implanted equipment

Cross reference to related applications

This application claims the power for the U.S. Provisional Patent Application Serial No. 62/438,822 submitted on December 23rd, 2016 Benefit, the disclosure of which are incorporated herein by reference.

Technical field

This disclosure relates to Medical Devices, and relate more specifically to the wireless communication between multiple implantable medical devices.

Background technique

Currently, implantable medical device is commonly used in monitoring the physiological parameter of patient or other parameters and/or pass to patient Send treatment.It, can be by various Medical Devices (for example, pacemaker, removing for example, in order to help the patient with heart associated disease Quiver device etc.) it is implanted in the internal of patient.Such equipment can monitor and provide electro photoluminescence (example to heart in some cases Such as pace-making, defibrillation) to help heart to operate with more normal, more efficient and/or safer mode.In another example, refreshing The tissue of patient can be used to stimulate through stimulator to help to relieve pain and/or other illnesss.It, can in another example again Implantable medical equipment can be only implantable monitor, monitor the one or more physiological parameters or other parameters of patient, And the parameter sensed is transmitted to another equipment, such as another implantable medical device or external equipment.In some cases, Two or more equipment cooperate to be monitored and/or be provided treatment.In in these examples some, it is expected when needed Communicate such equipment with other equipment.

Summary of the invention

The present disclosure describes implantable medical device (IMD), such as, but not limited to leadless cardiac pacemaker (LCP), mind Through stimulator (NS) and/or implantable monitor (IM), it is configured with more than one communication pattern and/or more than one Communication vector is communicated.In some cases, implantable medical device can be configured as communication pattern, vector and/or Switch between communication path, this can help to improve the communication reliability and/or communication speed between equipment.

In one example, implantable medical device (IMD) can be configured as and be implanted at least two in the patient A other implantable medical devices (IMD) communication.IMD may include shell, telecommunication circuit and be operatively coupled to communicate The controller of circuit.Controller can be configured as be based at least partially on multiple communication link quality values select to be used for and its The communication path and/or communication pattern that a selected IMD in his IMD is communicated, multiple communication link quality value with can Be used in in other IMD selected by multiple communication paths for being communicated of an IMD and/or multiple communication patterns it is associated. In some cases, controller, which can be configured as, uses selected communication path and/or communication pattern via telecommunication circuit With in other IMD selected by an IMD communicated.

Alternatively or additionally, controller can be based at least partially on one or more sensors input to select to lead to Believe path and/or communication pattern.

Alternatively or additionally for any of above embodiments, one or more sensors input may include one A or multiple physiology inputs.

Alternatively or additionally for any of above embodiments, one or more physiology inputs may include impedance One or more of input, posture input and heart rate input.

Alternatively or additionally for any of above embodiments, one or more sensors input may include electricity The input of pond life sensor.

Alternatively or additionally for any of above embodiments, controller can also be based at least partially on more Power consumption consumed by each of a communication path and/or multiple communication patterns selects communication path and/or communication pattern.

Alternatively or additionally for any of above embodiments, controller can also be based at least partially on multiple The data transfer rate of each of communication path and/or multiple communication patterns selects communication path and/or communication pattern.

Alternatively or additionally for any of above embodiments, if multiple communication link quality values change at any time Become, then controller can choose new communication path and/or communication pattern.

Alternatively or additionally for any of above embodiments, multiple when there are more than one communication path Communication path may include two or more communication paths using different vectors.

Alternatively or additionally for any of above embodiments, multiple when there are more than one communication pattern Communication pattern may include two or more in conduction-type communication, induction type communication, RF communication, acoustic communication and optical communication It is a.

Alternatively or additionally for any of above embodiments, multiple when there are more than one communication path Communication path may include direct communication path and indirect communication path.

Alternatively or additionally for any of above embodiments, IMD can be subcutaneous implantable cardiac conversion and remove Quiver device (SICD), and a selected IMD can be leadless cardiac pacemaker (LCP) in other IMD.

Alternatively or additionally for any of above embodiments, IMD can be leadless cardiac pacemaker (LCP)。

Alternatively or additionally for any of above embodiments, IMD can be maincenter (hub), and at least two Other a implantable medical devices (IMD) can be the satellite (satellite) of the maincenter.

Alternatively or additionally for any of above embodiments, IMD can be configured as via telecommunication circuit with One or more non-implantable devices of patient-external communicate.

In another example, implantable medical device (IMD) can be configured as and be implanted at least one in the patient A other implantable medical devices (IMD) communication.IMD may include shell and three or more for being exposed on hull outside Electrode.IMD may include being operatively coupled to the telecommunication circuit of three or more electrodes and being operatively coupled To the controller of telecommunication circuit.Controller can be configured as: when a pair of electrodes corresponded in three or more electrodes The first conduction-type communication vector provide it is logical with first IMD at least one other implantable medical device (IMD) When believing link (it best meets predetermined link quality criteria), vector is communicated using first conduction-type via telecommunication circuit It is communicated with first IMD at least one other IMD.In some cases, controller can be configured as: work as correspondence Second pair of electrode in three or more electrodes the second conduction-type communication vector provide at least one other IMD First IMD communication link (it best meets predetermined link quality criteria) when, use described the via telecommunication circuit Two conduction-types communication vector is communicated with first IMD at least one other IMD.

Alternatively or additionally for any of above embodiments, IMD can be configured as and be implanted in patient The communication of other implantable medical devices (IMD) of interior at least two, and controller can be configured as, even if when controller is wanted It is logical with the first conduction-type also to use when being communicated with first IMD in other IMD to communicate vector using the first conduction-type The different conduction-type of letter vector communicates vector to be communicated with second IMD at least two other IMD.

Alternatively or additionally for any of above embodiments, controller can be configured as repeatedly assessment which A communication vector best meets predetermined link quality criteria.

Alternatively or additionally for any of above embodiments, IMD can be subcutaneous implantable cardiac conversion and remove Quiver device (SICD), and first IMD at least one other IMD can be leadless cardiac pacemaker (LCP).

In another example, implantable medical device (IMD) can be configured as and at least two in implantation patient The communication of other implantable medical devices (IMD).IMD may include shell, telecommunication circuit and be operatively coupled to communicate electricity The controller on road.Controller can be configured as to receive during the first broadcast window and broadcast the message and whether determine broadcast message It is addressed to IMD.It is addressed to IMD in response to discovery broadcast message, controller can be in second after the first broadcast window Broadcast acknowledgements message during broadcast window.It is not addressed to IMD in response to discovery broadcast message, controller can determine another IMD whether during the second broadcast window broadcast acknowledgements message.In response to finding that another IMD is broadcasted during the second broadcast window Confirmation, controller replay broadcast message not during the third broadcast window after the second broadcast window.It is another in response to finding IMD does not have broadcast acknowledgements during the second broadcast window, and controller can be in the third broadcast window after the second broadcast window Period replay broadcast message.

The each disclosed embodiment for being not intended to the description disclosure or each outlined above of some illustrative embodimentss Embodiment.Following attached drawing and detailed description is more particularly exemplified some in these embodiments.

Detailed description of the invention

Consider that the disclosure can be more fully understood in conjunction with the described in detail below of attached drawing, in the accompanying drawings:

Fig. 1 is the schematic diagram according to the system of the exemplary implantable medical device (IMD) of the disclosure；

Fig. 2 is according to the schematic diagram of the exemplary IMD system of the disclosure, and wherein one in IMD is used as maincenter and other IMD is used as satellite；

Fig. 3 is the schematic frame of the workable illustrative leadless cardiac pacemaker (LCP) in the system of Fig. 1 and Fig. 2 Figure；

Fig. 4 is the workable illustrative subcutaneous implantable cardiac cardioverter defibrillators (SICD) in the system of Fig. 1 and Fig. 2 Schematic block diagram；

Fig. 5 is the schematic block diagram of the workable illustrative IMD in the system of Fig. 1 and Fig. 2；

Fig. 6 is the schematic block diagram of the workable illustrative IMD in the system of Fig. 1 and Fig. 2；

Fig. 7 is the more detailed schematic block diagram according to the exemplary illustrative LCP of the disclosure；

Fig. 8 can be used for the schematic block diagram for another illustrative Medical Devices being used in combination with the LCP of Fig. 7；

Fig. 9 be include the multiple LCP to communicate with one another and/or other equipment example medical system schematic diagram；

Figure 10 is the schematic diagram according to the exemplary system including LCP and another Medical Devices of the disclosure；

Figure 11 is similar to Fig. 2, but there is provided the illustrative of the communication link quality value under first group of operating condition but Unrestricted example；And

Figure 12 provides the illustrative but unrestricted example of the communication link quality value under second group of operating condition.

Although the disclosure can be accepted in various modifications and alternative form, its details has passed through the example quilt in attached drawing It shows and will be described in detail.It should be understood, however, that being not intended to for the disclosure to be limited to described particular implementation Example.On the contrary, it is intended to be to cover all modifications, equivalents, and substitutions scheme fallen into spirit and scope of the present disclosure.

Specific embodiment

For term defined below, different determine unless providing elsewhere in claim or in the present specification Otherwise justice should be applicable in these definition.

Assume that all numerical value are modified by term " about " herein, regardless of whether explicitly pointing out.Term " about " typically refers to this Field technical staff will be considered that the digital scope for being equivalent to described value (that is, function having the same or result).In many situations Under, term " about " may include being rounded up to the number of immediate effective digital.

By endpoint state numberical range include within the scope of this it is all number (for example, 1 to 5 include 1,1.5,2,2.75, 3,3.80,4 and 5).

As used in the specification and the appended claims, except non-content is otherwise expressly specified, otherwise singular shape Formula " one ", "one" and "the" include plural referents.As used in the specification and the appended claims, unless Content is otherwise expressly specified, otherwise term "or" usually with the meaning that it includes "and/or" come using.

It should be noted that showing institute to the reference of " embodiment ", " some embodiments ", " other embodiments " etc. in specification The embodiment of description may include one or more special characteristics, structure and/or characteristic.However, such statement might not Mean that all embodiments all include special characteristic, structure and/or characteristic.In addition, when combining one embodiment to describe specific spy Sign, structure and/or when characteristic, it should be understood that unless otherwise expressly provided, otherwise these features, structure and/or characteristic Can with regardless of whether the other embodiments being explicitly described are used in combination.

The attached drawing that should refer to number identical similar structures in different figures is described in detail below to read.Not necessarily Attached drawing drawn to scale depicts illustrative embodiments, and is not intended to be limited to the scope of the present disclosure.Although the disclosure is applicable in In any suitable implantable medical device (IMD), but it is described below and often uses pacemaker and more specifically use nothing Leadless cardiac pacemaker (LCP) is as a specific example.

Fig. 1 is to show the schematic diagram that can be used for the demonstrative system 10 for sensing and/or pacing heart H.In some feelings Under condition, system 10 can be additionally configured to electric shock heart H.Heart H includes atrium dextrum RA and right ventricle RV.Heart H further includes a left side Atrium LA and left ventricular LV.In some cases, system 10 may include that can monitor heart H and/or provide treatment to heart H Two, three, four, or more Medical Devices.Medical Devices can broadly monitor patient and/or to patient Treatment is provided.

In some cases, as shown, for example in fig. 1, system 10 may include implantable medical device (IMD) 12, IMD 14, IMD 16 and IMD 18.In some cases, system 10 also may include optional equipment.In some cases, system 10 can To include the less IMD of IMD 12,14,16,18 than diagram.Each of IMD 12,14,16,18 can be any conjunction Suitable Medical Devices, such as, but not limited to leadless cardiac pacemaker (LCP), can plant at implantable cardiac cardioverter defibrillators (ICD) Enter nerve stimulator (NS), implantable monitor (IM) and/or any other suitable Medical Devices.

In some cases, one or more of IMD 12,14,16,18 can be implanted in heart H, on heart H Or near heart H.In some cases, for example, one or more of IMD 12,14,16,18 can near heart H or Even it is implanted in the patient at the position in heart H.In some cases, other IMD in IMD 12,14,16,18 can At the subcutaneous position that is implanted in patient chest.In some cases, one or more of IMD 12,14,16,18 can To be configured as the electrocardio-activity of sensing heart H and provide treatment electric pulse to heart H.In some cases, for example, IMD 12, at least one of 14,16,18 it can be leadless cardiac pacemaker (LCP) and can be configured as to heart H offer Pacemaker impulse.In some cases, another in IMD 12,14,16,18 can be subcutaneous implantable cardiac cardioverter defibrillators (SICD) it and can be configured as to heart H offer shock pulse.

It will be appreciated that IMD 12,14,16,18 can be used any desired communication form (such as conduction-type communication, Induction type communication, acoustic communication, RF communication, optical communication) and/or any other suitable communication form is used, to lead to each other Letter, and possibly communicated with external equipment (such as, but not limited to programmable device).In some cases, such as IMD 12,14, 16,18 Medical Devices can be configured as using two or more different communication patterns, communication path and/or communication arrow Amount is communicated, this is depended on, and in specific time, for particular communications needs, what is most effective.It will be appreciated that different Communication pattern can have different power demands, different efficient communication ranges, different signal-to-noise ratio etc..In some cases Under, for example, Medical Devices can use the first communication pattern required with relative low power when the first communication pattern is effective It is communicated, and when the failure of the first communication pattern, Medical Devices can be switched to the with relatively high power requirement Two communication patterns.

In some cases, Medical Devices can select specifically to communicate based on the identity of another equipment and/or position Mode.For example, if another in one and IMD 12,14,16,18 in IMD 12,14,16,18 is all implanted in trouble In person, it is assumed that there is the communication vector that can be worked between two IMD, then they can communicate via conduction-type and lead to each other Letter.In some cases, other communication patterns, such as, but not limited to induction type communication, RF communication, acoustic communication can be used And/or optical communication.In some cases, each of IMD 12,14,16,18 can along specific communication path and It communicates with one another.It is communicated for example, IMD 12 can be transmitted along communication path 12a to IMD 14.IMD 12 can be along communication lines Diameter 12b is transmitted to IMD 16 and is communicated.IMD 12 can be transmitted to IMD 18 along communication path 12c and be communicated.Similarly, 14 IMD It can transmit and communicate to IMD 18 along communication path 14a.IMD 14 can transmit along communication path 14b to IMD 12 logical Letter.IMD 14 can be transmitted to IMD 16 along communication path 14c and be communicated.IMD 16 can be along communication path 16a to IMD 12 transmission communications.IMD 16 can be transmitted to IMD 18 via communication path 16b and be communicated.IMD 16 can be via communication path 16c is transmitted to IMD 14 and is communicated.IMD 18 can be transmitted to IMD 16 via communication path 18a and be communicated.IMD 18 can be via Communication path 18b is transmitted to IMD 14 and is communicated.IMD 18 can be transmitted to IMD 12 via communication path 18c and be communicated.

These paths are considered directapath, and specific IMD can be specific with another by the directapath IMD is directly communicated.In some cases, the communication for being directed toward specific IMD can be connect by two or more different IMD It receives.Directapath is considered referring to the communication path directly from an IMD to another IMD, wherein communication is intended to from an IMD It is passed directly to another IMD, and whether by any auxiliary IMD is seen and/or received unrelated with communication.In some cases, IMD It can be communicated via indirect path with another IMD.For example, it is assumed that IMD 12 it is expected to transmit message to IMD 18, but due to certain Kind reason, communication path 12c are effectively or efficient not as good as indirect path.When it happens, IMD 12 can be along communication path 12a Message is sent to IMD 14.IMD 14 can receive message from IMD 12, and can transfer it to along communication path 14a IMD 18.This is only an example.It will be appreciated that there are the combination of many communication paths, in IMD 12,14,16,18 one It is a to be communicated by it with one or more of IMD 12,14,16,18 other IMD.

In some cases, and as shown in Figure 1, hierarchical relationship is not present between IMD 12,14,16,18.Namely It says, IMD 12,14,16,18 can play equivalent.However, in some cases, if necessary to IMD 12,14,16, One in 18 undertakes leader position, then one in IMD 12,14,16,18 can do so, this is for example depending on IMD 12, it which of 14,16,18 is most suitable for or is oriented to do so.In some cases, IMD 12,14,16,18 can be with More take traditional maincenter-satellite or planet-satellite relationship.In some cases, it will be appreciated that, maincenter-satellite system System may include maincenter, usually have more computing capabilitys, more battery lifes, more memories, and some In the case of can be configured as to be transmitted relative to the higher power level of any of satellite.In some cases, For example, particular device can be designated as maincenter, and other equipment are appointed as satellite.In other cases, which equipment is used as Maincenter and which equipment, which are used as satellite, to change over time, such as most complete to remote equipment progress based on which equipment Transmission or which equipment have maximum residual battery capacity etc..

Fig. 2 provides the example for the system 20 that can be used to sensing and/or pacing heart H.In some cases, system 20 can be additionally configured to electric shock heart H, and can set for example including two, three, four, or more medical treatment It is standby, it can monitor heart H and/or antiarrhythmic therapy can be provided to heart H.In some cases, system 20 can be with Including maincenter (HUB) 22, satellite ONE (SAT) 24, SAT TWO 26 and SAT THREE 28.In some cases, system 20 It may include optional equipment.In some cases, system 20 may include the less SAT of SAT 24,26,28 than diagram.? Under some cases, HUB 22 can be any suitable Medical Devices, such as, but not limited to leadless cardiac pacemaker (LCP), Implantable cardiac cardioverter defibrillators (ICD), implantable nerve stimulator (NS), implantable monitor (IM) and/or any other Suitable Medical Devices.In some cases, each of SAT 24,26,28 can be any suitable Medical Devices, all Such as, but not limited to, leadless cardiac pacemaker (LCP), implantable cardiac cardioverter defibrillators (ICD), implantable nerve stimulator (NS), monitor (IM) and/or any other suitable Medical Devices be can plant.In some cases, setting as HUB 22 It is constant for can be over time.In some cases, if appropriate, being used as the equipment of one of SAT 24,26,28 sometimes It may be used as HUB 22.

In some cases, one or more of HUB 22 and/or SAT 24,26,28 can be implanted in heart H On interior, heart H or near heart H.In some cases, one or more of HUB 22 and/or SAT 24,26,28 can be with It is configured as the electrocardio-activity of sensing heart H and provides treatment electric pulse to heart H and/or provide shock pulse to heart H.

It will be appreciated that any desired communication form (such as conduction-type can be used in HUB 22 and SAT 24,26,28 Communication, induction type communication, acoustic communication, RF communication, optical communication) and/or using any other suitable communication form, and that This communication, and possibly communicated with external equipment (such as, but not limited to programmable device).In some cases, such as HUB 22 And/or the Medical Devices of SAT 24,26,28 can be configured as and use two or more different communication patterns, communication lines Diameter and/or communication vector are communicated, this is depended on, and in specific time, for particular communications needs, what is most effective.It will reason Solution, different communication patterns can have different power requirements, different efficient communication ranges and different signal-to-noise ratio Deng.In some cases, HUB 22 can be configured as via several different communication patterns or vector while communicate.For example, HUB 22 can be used the first communication pattern and/or vector and be communicated with the first equipment, and simultaneously using second, it is different logical Letter mode and/or vector are communicated with the second equipment, this is for example depending on timing requirements and/or data transmission rate demand.

In some cases, for example, Medical Devices can be used with relatively low function when the first communication pattern is effective The first communication pattern that rate requires is communicated, and when the failure of the first communication pattern, Medical Devices, which can be switched to, to be had Second communication pattern of relatively high power requirement.In some cases, system 20 can will be in equipment 22,24,26 and 28 One is assigned as HUB equipment, and remaining equipment is assigned as satellite equipment.The distribution can be fixed, or can be with item Part variation is changed by system.

In some cases, for example, HUB 22 and/or can be sometimes used as in the SAT 24,26,28 of maincenter equipment one It is a that periodical test can be carried out by all communication paths, determine the link margin (margin) of each communication path, and And one or more communication paths appropriate with highest link margin are then selected when it is expected communication between equipment, such as But it is not limited to manage A-V timing or V-V timing etc. between heart equipment.In some cases, maincenter equipment can calculate logical Believe the score in each of path, and these scores can be made associated with the physiology input data of such as posture.In the middle It is pivoted standby it is later determined that or when being apprised of the variation of physiology input data, maincenter equipment can automatically switch one accordingly used A or multiple communication paths.In some cases, user can provide input data, all A-V timings as desired, desired V- V timing etc., and maincenter equipment can automatically change or correspondingly optimize the usage of communication path.

In some cases, equipment can communicate with one another along specific communication path.For example, HUB 22 can be along logical Believe that path 22a is transmitted to SAT ONE 24 to communicate.HUB 22 can transmit along communication path 22b to SAT THREE 28 logical Letter.HUB 22 can be transmitted to SAT TWO 26 along communication path 22c and be communicated.Similarly, SAT ONE 24 can be along logical Believe that path 24a is transmitted to HUB 22 to communicate.SAT ONE 24 can transmit along communication path 24b to SAT THREE 28 logical Letter.SAT ONE 24 can be transmitted to SAT TWO 26 along communication path 24c and be communicated.SAT TWO 26 can be along communication lines Diameter 26a is transmitted to HUB 22 and is communicated.SAT TWO 26 can be transmitted to SAT THREE 28 via communication path 26b and be communicated.SAT TWO 26 can be transmitted to SAT ONE 24 via communication path 26c and be communicated.SAT THREE 28 can be via communication path 28a It transmits and communicates to SAT ONE 24.SAT THREE 28 can be transmitted to HUB 22 via communication path 28b and be communicated.SAT THREE 28 can be transmitted to SAT TWO 26 via communication path 28c and be communicated.

These paths are considered directapath, and particular device specific can be set by the directapath with another Standby direct communication.In some cases, the communication for being directed toward particular device (such as HUB 22 and/or SAT 24,26,28) can be by Two or more distinct devices receive.Directapath is considered referring to directly from an equipment to the communication lines of another equipment Diameter, wherein communication is intended to be passed directly to another equipment from an equipment, and with communicate whether seen by any ancillary equipment and/or It receives unrelated.In some cases, equipment can via indirect path (for example, by one or more other equipment) with it is another The communication of one equipment.For example, it is assumed that HUB 22 wishes to transmit message to SAT ONE 24, but for some reason, communication path 22a It is invalid or not efficient.For example, HUB 22 can send message to SAT THREE 28 along communication path 22b.SAT THREE 28 can receive message from HUB 22, and SAT ONE 24 can be transferred it to along communication path 28a.This is only It is only an example.It will be appreciated that there are the combination of many communication paths, one in HUB 22 and/or SAT 24,26,28 It can be communicated by it with other one or more in HUB 22 and/or SAT 24,26,28.

In some cases, when the one equipment needs in such as SAT 24,26,28 are communicated with another equipment, the phase Hope that the equipment of communication can be with on-air testing message and then snoop responses.If receiving response, next can be broadcasted Message such as data.If being not received by response, it is expected that the equipment of communication can according to can be arranged during manufacture or The interval being arranged at the scene again attempts to.Once response is received, or if receiving multiple responses, it is expected that the equipment of communication Can measure the signal strength of each response, select peak signal, and require the equipment to another equipment (such as but not It is limited to HUB 22) it re-broadcasts.Response time can be based on many factors, including but not limited to sequence number, device address, heart Periodically (such as after Vsense or Asense or at the end of Refractory) or random time.

In some cases, each equipment may include can with its best (strongest signal strength) and its second-best ( Two strong signal intensity) establish the algorithm communicated.Then can be existed with carrousel (merry go round) or daisy chaining Message is delivered between equipment everywhere.In some cases, these message will be added label to them to identify which or which Equipment has received that particular message.Once all devices have all identified that outbound message has been received, transmission can be terminated.If special Locking equipment is difficult to position, then other communication path/vectors that may be less strong are likely to be used.In some cases, depend on Can be communicated each other in distinct device it is how well, can establish it is multiple and/or overlapping communications loop.For example, communication Loop may include as little as two equipment.In some cases, in order to save power, the information only changed recently can be passed It send.For example, information only can just be transmitted in the case where having changed since the last item message, or perhaps exist It can be transmitted in the case where having had occurred that n interval since the previous communication.For example, n interval can be it is programmable.

In some cases, one or more of IMD 12,14,16,18 (Fig. 1) or HUB 22 and SAT 24,26, One or more of 28 (Fig. 2) can be leadless cardiac pacemaker (LCP).Fig. 3 is illustrative leadless cardiac pacemaker (LCP) 30 schematic diagram.In some cases, LCP 30 may include shell 32 and a pair of electrodes fixed relative to shell 32 34,36.Though it is shown that two electrodes 34,36, it is to be understood that in some cases, LCP 30 may include three Or more electrode.Controller 38 is arranged in shell 32, and controller 38 can be respectively via electric connector 35 and 37 Electrode is operatively coupled to 34,36.Power supply 40 is operatively coupled to controller 38, and provides for operating control The power of device 38 and offer are for generating the function for the pacemaker impulse that can be delivered via electrode 34,36 by controller 38 Rate.In some cases, controller 38, which may be considered that, is configured as generating and deliver multiple pace-makings to 34,36 via electrode Pulse.In some cases, LCP 30 may include communication module 42, be operatively coupled to controller 38 and can be with It is configured as sending and receiving message from other equipment.In some cases, for example, LCP 30 may include such as accelerometer Or one or more other sensors of gyroscope.

In some cases, one or more of IMD 12,14,16,18 (Fig. 1) or HUB 22 and SAT 24,26, One or more of 28 (Fig. 2) can be subcutaneous implantable cardiac cardioverter defibrillators (SICD).Fig. 4 is subcutaneous implantable cardiac The schematic diagram of cardioverter defibrillators (SICD) 50.In some cases, SICD 50 includes shell 52 and is operatively coupled to shell The electrode supporting piece 54 of body 52.In some cases, electrode supporting piece 54, which can be configured as, places one or more electrodes In such as subcutaneous or infrasternal position, this makes one or more electrodes be able to detect electrocardio-activity and can be in due course It delivers and shocks by electricity to heart H.In the example shown, shell 52 can accommodate controller 56, power supply 58 and communication module 60.As institute Show, electrode supporting piece 54 includes first electrode 62, second electrode 64 and third electrode 66.In some cases, electrode supporting piece 54 may include less or more electrode.In some cases, for example, SICD 50 may include such as accelerometer or top One or more other sensors of spiral shell instrument.

Fig. 5 is the schematic block diagram of illustrative implantable medical device (IMD) 70, and IMD 70 is configured to and is implanted in trouble Intracorporal at least two other IMD of person communication.It will be appreciated that for example, IMD 70 is considered IMD 12,14,16,18 One example in one in (Fig. 1), HUB 22 and/or SAT 24,26,28 (Fig. 2).IMD 12,14,16,18,HUB 22 and/or SAT 24,26,28 may be considered the example that IMD 70 is configured as at least two other IMD communicated.It says Bright property IMD 70 includes shell 72.Telecommunication circuit 74 can be arranged in shell 72.Controller 76 can be by operationally coupling Close telecommunication circuit 74.Power supply 78 can be operatively coupled to controller 76, and power supply 78 can be provided for operating The power of controller 76 and the other function for IMD 70.In some cases, IMD 70 is SICD, and other IMD In one be LCP.In some cases, IMD 70 can be LCP.In some cases, IMD 70 can serve as maincenter, and And at least two other IMD can be the satellite of maincenter.

In some cases, controller 76 can be configured as, be based at least partially on multiple communication link quality values or Measurement 80 come select for in other IMD selected by an IMD communication path and/or communication pattern that are communicated, this is more A communication link quality value or measurement 80 can with can be used for being communicated with the selected IMD in other IMD it is multiple Communication path and/or multiple communication patterns are associated.In some cases, at least some of communication link quality value 80 can be with It is internally determined by controller 76.In some cases, at least some of communication link quality value 80 can be remote from IMD 70 Journey it is determining, and can for example be sent to IMD 70.

In some cases, controller 76, which can be configured as, is based at least partially on one or more sensors input 82 To select communication path and/or communication pattern.In some cases, at least some of sensor input 82 can be by controller 76 internally determine (for example, internal sensor that IMD 70 can have their own).In some cases, sensor input 82 At least some of can remotely be determined from IMD 70, and can for example be sent to IMD 70.In some cases, it passes Sensor input 82 may include one or more physiology inputs related with the current health of patient or state.For example, one or Multiple physiology inputs may include one or more of impedance input, posture input and/or heart rate input.In some cases Under, one in sensor input 82 may include the input of battery life sensor, can for example provide in power supply 78 And/or the instruction of the dump power in the battery in an IMD in other IMD that communicate of IMD 70.

In some cases, controller 76, which can be configured as, is based at least partially on multiple communication paths and/or multiple Power consumption consumed by each of communication pattern selects communication path and/or communication pattern.In some cases, controller 76 can be configured as the data transfer rate for being based at least partially on each of multiple communication paths and/or multiple communication patterns Select communication path and/or communication pattern.In some cases, controller 76 can be configured as be based at least partially on it is multiple The signal-to-noise ratio of communication path and/or multiple communication patterns selects communication path and/or communication pattern.In some cases, such as The multiple communication link quality values of fruit change over time, then controller 76 can choose new communication path and/or communication pattern.

In some cases, multiple communication paths (if there is more than one communication path) may include using not With two or more communication paths of vector.In some cases, multiple communication patterns are (if there is more than one communication mould If formula) it may include conduction-type communication, induction type communication, RF communication, two or more in acoustic communication and optical communication It is a.In some cases, multiple communication paths (if there is more than one communication path) include direct communication path and/ Or indirect communication path.In some cases, controller 76 can be configured as, and using selected communication path and/or lead to Letter mode is communicated via telecommunication circuit 74 with the selected IMD in other IMD.In some cases, 70 IMD Can be configured as and communicated via telecommunication circuit with one or more non-implantable devices of patient-external, this sometimes through It is carried out using the communication pattern different when being communicated from other implanteds IMD.

In some cases, controller 76 can be configured as during the first broadcast window receive broadcast message and really Whether the fixed received broadcast message of institute is addressed to IMD 70.If the received broadcast of institute is addressed to IMD 70, controller 76 can be configured as the broadcast acknowledgements message during the second broadcast window after the first broadcast window.However, if being connect The broadcast message of receipts is not addressed to IMD 70, then controller 76, which can be configured as, determines whether another IMD is wide second Confirmation message has been broadcast during broadcasting window.If it is, controller 76 can be configured as after the second broadcast window Third broadcast window during do not replay broadcast message.If it is not, then controller 76, which can be configured as, broadcasts window second Broadcast message is replayed during third broadcast window after mouthful.This is an example of system, and wherein communication path is not preparatory It is determining, but to be determined based on condition or adaptive mode.

Fig. 6 is the schematic block diagram of implantable medical device (IMD) 90, and IMD 90 is configured as and is implanted in patient's body Other IMD of interior at least two communication.It will be appreciated that IMD 70 can for example be considered as IMD 12,14,16,18 (Fig. 1) In one, one example in HUB 22 and/or SAT 24,26,28 (Fig. 2).IMD 12,14,16,18, HUB 22 and/ Or SAT 24,26,28 is considered the example that IMD 70 is configured as at least two other IMD communicated.One In a little situations, IMD 90 can be SICD, and first IMD at least one other IMD can be LCP.Illustrative IMD 90 include shell 92, and wherein telecommunication circuit 74 is arranged in shell 72.Controller 76 can be operatively coupled to communicate Circuit 74.Power supply 78 is operatively coupled to controller 76, and provides the power for the operation for being used for controller 76 and mention For the power of the other function for IMD 90.

In some cases, IMD 90 may include three or more electrodes being exposed on outside shell 92.As institute Show, IMD 90 includes electrode 94, electrode 96 and electrode 98, respectively via connector link 95,97 and 99 by operationally It is coupled to telecommunication circuit 74.In some cases, controller 76 can be configured as: using the first conduction-type communication vector via Telecommunication circuit 74 is communicated with first IMD at least one other implantable medical device (IMD), first conduction-type Communicate vector correspond to three or more electrodes 94,96,98 in a pair of electrodes, provide with it is at least one other First IMD in IMD, best meet the communication link of predetermined link quality criteria.In some cases, it controls Device 76 can be configured as: when the second conduction-type of the second pair of electrode corresponded in three or more electrodes 94,96,98 is logical Letter vector provides communication with first IMD at least one other IMD, best meeting predetermined link quality criteria When link, using second conduction-type communication vector via first IMD in telecommunication circuit 74 and at least one other IMD It is communicated.This is only an example.

In some cases, controller 76 can be configured as: even if when controller 76 uses the first conduction-type communication arrow It measures when being communicated with first IMD in other IMD, also to use the conduction-type different from the first conduction-type communication vector logical Vector is believed to be communicated with second IMD at least two other IMD.In some cases, controller 76 can be matched It is set to repeatedly to assess and communicates to meet predetermined link quality criteria using which communication vector and correspondingly change Communicate vector.

Fig. 7 depicts another exemplary leadless cardiac pacemaker (LCP), can be implanted to patient's body and can , to cardiac delivery treatment appropriate, anti-tachyarrhythmia pacemaker (ATP) treatment, cardiac resynchronization therapy are such as delivered to operate (CRT), bradycardia treatment etc..As can see in Fig. 7, LCP 100 can be compact device, wherein all components It is accommodated in shell 120 or directly on shell 120.In some cases, LCP 100 is considered the (figure of LCP 30 1) example.In the example depicted in fig. 7, LCP 100 may include: communication module 102, pulse generator module 104, inductance Survey module 106, mechanical sensing module 108, processing module 110, battery 112 and electrode arrangement 114.Depending on application, LCP 100 It may include more or fewer modules.

Communication module 102 can be configured as the equipment and/or such as with such as sensor being located at outside LCP 100 Other Medical Devices of SICD etc. are communicated.Such equipment can be located at the outside or inside of patient body.Regardless of position How, external equipment (that is, in the outside LCP 100 but not necessarily in the outside of patient body) can via communication module 102 with The communication of LCP 100 is to realize one or more desired functions.For example, LCP 100 can be by the electric signal such as sensed, number External medical equipment is transmitted to (for example, SICD by communication module 102 according to the information of, instruction, message, R wave detection label etc. And/or programmable device).External medical equipment can be used transmitted signal, data, instruction, message, R wave detection label etc. and come It performs various functions, such as to determine that the generation of arrhythmia cordis, delivering electronic stimulation, the storage data and/or execution that receive Any other suitable function.LCP 100 can additionally by communication module 102 from external medical equipment receive such as signal, The information of data, instruction and/or message, and LCP 100 can be used the signal received, data, instruction and/or message and come It performs various functions, such as to determine that the generation of arrhythmia cordis, delivering electronic stimulation, the storage data and/or execution that receive Any other suitable function.Communication module 102 can be configured as using one or more methods come with external device communication. For example, communication module 102 can be communicated via radio frequency (RF) signal, induction type coupling, optical signalling, acoustic signal, conduction-type Signal and/or any other signal for being suitable for communication are communicated.

In the example depicted in fig. 7, pulse generator module 104 may be electrically coupled to electrode 114.In some examples In, LCP 100 can also comprise electrode 114 '.In such an example, impulse generator 104 is also electrically connected to electricity Pole 114 '.Pulse generator module 104 can be configured as generation electrical stimulation signal.For example, pulse generator module 104 can be with Electrical stimulation signal is generated and delivers by using the energy in the battery 112 being stored in LCP 100, and via electrode 114 and/or electrode 114 ' deliver electrical stimulation signal generated.Alternatively or additionally, impulse generator 104 can wrap One or more capacitors are included, and impulse generator 104 can be by drawing energy from battery 112 come to one or more electricity Container charges.Then, the energy that one or more capacitors can be used in impulse generator 104 come via electrode 114 and/ Or electrode 114 ' delivers electrical stimulation signal generated.In at least some examples, the impulse generator 104 of LCP 100 can be with Including switching circuit, one or more of electrode 114 and/or electrode 114 ' are selectively connected to impulse generator 104, electric thorn is delivered for impulse generator 104 to select which electrode in electrode 114/114 ' (and/or other electrodes) Swash treatment.Pulse generator module 104, which can be generated and deliver, has special characteristic or the electrical stimulation signal under particular sequence, In order to provide one or more of many different stimulateds treatment.For example, pulse generator module 104 can be configured as generation Electrical stimulation signal is to provide for inhibiting bradycardia, tachycardia, cardiac synchronous, bradycardia arrhythmia cordis, tachycardia Arrhythmia cordis, fibrillation arrhythmia cordis, cardiac synchronous arrhythmia cordis electronic stimulation and/or generate any other suitable electricity thorn Swash treatment.Some more common electronic stimulation methods include anti-tachyarrhythmia pacemaker (ATP) treatment, cardiac resynchronization therapy (CRT) and cardioversion/defibrillation therapy.In some cases, impulse generator 104 can provide controllable pulse energy.? Under some cases, impulse generator 104 can permit controller control pulse voltage, pulse width, pulse shape or form, And/or any other suitable pulse characteristic.

In some instances, LCP 100 may include electrical sensing module 106, and in some cases, LCP 100 can To include mechanical sensing module 108.Electrical sensing module 106 can be configured as the electrocardio-activity of sensing heart.For example, electrical sensing Module 106 may be coupled to electrode 114/114 ', and electrical sensing module 106 can be configured as reception and pass through electrode 114/ The electrocardiosignal of 114 ' conduction.Electrocardiosignal can show the local message from the chamber for wherein implanting LCP 100.Example Such as, if LCP 100 is implanted in the intra-ventricle (for example, RV, LV) of heart, felt by LCP 100 by electrode 114/114 ' The electrocardiosignal measured can indicate ventricle electrocardiosignal.In some cases, LCP 100 can be configured as detection from it The electrocardiosignal of his chamber (such as far field), such as the P wave from atrium.

Mechanical sensing module 108 may include one or more sensors, such as accelerometer, pressure sensor, heart sound Sensor, blood oxygen transducer, chemical sensor, temperature sensor, flow sensor, and/or it is configured as the one of measurement patient Any other suitable sensor of a or multiple mechanical/chemical parameters.Electrical sensing module 106 and mechanical 108 liang of sensing module Person can be connected to processing module 110, and processing module 110 can provide the signal for indicating the mechanical parameter sensed.Though So it is described as isolated sensing module about Fig. 7, but in some cases, as needed, electrical sensing module 206 and machinery Sensing module 208 can be combined into single sense module.

Electrode 114/114 ' can be fixed relative to shell 120, but the tissue that is exposed to around LCP 100 and/or Blood.In some cases, electrode 114 can be generally arranged in the either end of LCP 100, and can with module 102, 104, one or more telecommunications in 106,108 and 110.Electrode 114/114 ' can be supported by shell 120, but some In example, electrode 114/114 ' can be connected to shell 120 by short connecting line, so that electrode 114/114 ' is not directly opposite It is fixed in shell 120.In the example that LCP 100 includes one or more electrodes 114 ', electrode 114 ' in some cases may be used To be arranged on the side of LCP 100, this can increase the quantity of electrode, can sense electrocardio by these electrodes LCP 100 Activity delivers electro photoluminescence and/or communicates with external medical equipment.Electrode 114/114 ' can be by one or more biocompatible Conductive material (such as known for being safe various metal or alloy in personal et al. Ke) composition.In some cases, The electrode 114/114 ' for being connected to LCP 100 can have insulated part, the insulated part make electrode 114/114 ' with it is adjacent The other parts of electrode, shell 120 and/or LCP 100 are electrically isolated.In some cases, one in electrode 114/114 ' or It is multiple to may be provided on the tail portion (not shown) extended far from shell 120.

Processing module 110 can be configured as the operation of control LCP 100.For example, processing module 110 can be configured as Electric signal is received from electrical sensing module 106 and/or mechanical sensing module 108.Based on the signal received, for example, processing module 110 can determine the exception in the operating of heart H.Based on any identified exception, processing module 110 can control pulse hair Raw device module 104 generates and delivers electro photoluminescence according to one or more therapies to treat identified exception.Processing module 110 Information can also be received from communication module 102.In some instances, this information received can be used in processing module 110 To assist in determining whether just to be abnormal, determine abnormal type, and/or take specific action in response to the information.Handle mould Block 110 can additionally control communication module 102 with to other equipment send information/from other equipment receive information.

In some instances, processing module 110 may include preprogrammed chips, such as ultra-large integrated (VLSI) chip And/or specific integrated circuit (ASIC).In such embodiments, chip can use control logic pre-programmed, to control LCP 100 operation.By using preprogrammed chips, processing module 110 be can be used than other programmable circuits (for example, general can Programming microprocessor) less power, while still being able to maintain basic function, to potentially increase the battery of LCP 100 Service life.In other examples, processing module 110 may include programmable microprocessor.This programmable microprocessor can permit The control logic of LCP 100 is even modified at family allowable after this, to allow LCP 100 than using tool when pre-programmed ASIC There is greater flexibility.In some instances, processing module 110 can also include memory, and processing module 110 can incite somebody to action Information storage reads information on a memory and from memory.In other examples, LCP 100 may include and processing module The single memory (not shown) of 110 communications allow processing module 110 from the single memory to read information and to the list Information is written in only memory.

Battery 112 can provide the power operated for it to LCP 100.In some instances, battery 112 can be not Rechargeable lithium-base battery.In other examples, as needed, non-rechargeable battery can be by other suitable materials It is made.Because LCP 100 is implantable devices, touching for LCP 100 may be restricted after the implantation.Therefore, it is desirable to It is controlled with enough battery capacities with being delivered during the treatment of such as a couple of days, several weeks, several months, several years or even many decades It treats.In some cases, battery 112 can be rechargeable battery, this can help to increase that the usable longevity of LCP 100 Life.In other examples again, as needed, battery 112 can be the power supply of some other types.

In order to which LCP 100 to be implanted into the body interior of patient, operator (for example, internist, clinician etc.) can be with Fixed LCP 100 arrives the heart tissue of patient's heart.For the ease of fixation, LCP 100 may include one or more anchors 116. Anchor 116 may include any one of many fixations or anchor mechanism.For example, anchor 116 may include one or more pins, U Staple, screw thread, screw, spiral, pointed tooth and/or analog.In some instances, although being not shown, anchor 116 can be in its appearance Include screw thread on face, can extend along at least partly length of anchor 116.Screw thread can be provided between heart tissue and anchor and be rubbed Power is wiped to help to fix anchor 116 in heart tissue.In other examples, anchor 116 may include other structures, such as barb, Or nail etc., in order to be engaged with surrounding heart tissue.

Fig. 8 depicts the example of another or the second Medical Devices (MD) 200, and can combine with LCP 100 (Fig. 7) makes With to detect and/or treat heart abnormality.In some cases, MD 200 is considered showing for SICD 50 (Fig. 4) Example.In the example shown, MD 200 may include: communication module 202, pulse generator module 204, electrical sensing module 206, Mechanical sensing module 208, processing module 210 and battery 218.Each of these modules can be similar to the mould of LCP 100 Block 102,104,106,108 and 110.In addition, battery 218 can be similar to the battery 112 of LCP 100.However, in some examples In, MD 200 can have bigger volume in shell 220.In such an example, MD 200 may include bigger electricity Pond and/or bigger processing module 210, with can the processing module 110 than LCP 100 handle more complicated operation.

While it is contemplated that be that MD 200 can be another no leadless device (as shown in Figure 7 all), but in some cases, MD 200 may include the lead of such as lead 212.Lead 212 may include in electrode 214 and one in shell 220 or The electric wire of electric signal is conducted between multiple modules.In some cases, lead 212 may be connected to the shell 220 of MD 200 And the shell 220 far from MD 200 extends.In some instances, lead 212 is implanted on patient's heart, heart is interior or the heart Near dirty.Lead 212 may include one or more electrodes 214, be positioned at the different location on lead 212, and It is positioned in some cases away from the different distance of shell 220.Some leads 212 can only include single electrode 214, and Other leads 212 may include multiple electrodes 214.In general, electrode 214 is positioned on lead 212, so as to work as 212 quilt of lead When being implanted in patient's body, one or more of electrode 214 is positioned as executing desired function.In some cases, electric One or more of pole 214 can be contacted with the heart tissue of patient.In some cases, one in electrode 214 or more A outside that can be subcutaneously positioned and be located in patient's heart.In some cases, electrode 214 can will intrinsically produce Electric signal (such as the signal for indicating intrinsic electrocardio-activity) be transmitted to lead 212.The electric signal that lead 212 can will receive Successively it is transmitted to one or more of the module 202,204,206 and 208 of MD 200.In some cases, MD 200 can be with Electrical stimulation signal is generated, and the electrical stimulation signal of generation can be transmitted to electrode 214 by lead 212.Then, electrode 214 can To conduct electric signal and the signal be delivered to the heart (either directly or indirectly) of patient.

As mechanical sensing module 108, mechanical sensing module 208 may include or be electrically connected to one or more It sensor, such as accelerometer, acoustic sensor, blood pressure sensor, heart sound transducer, blood oxygen transducer and/or is configured as Measure the other sensors of heart and/or one or more mechanical/chemical parameters of patient.In some instances, in sensor One or more can be located on lead 212, but this is not required.In some instances, one in sensor or more It is a to be located in shell 220.

Although it is not required, but in some instances, MD 200 can be implantable medical device.In such example In, the shell 220 of MD 200 can be implanted in such as patient through in thorax region.Shell 220 usually may include following Any of many known materials, in human body implantation be it is safe and when implanted, can be from patient The fluid of body and tissue are by the various parts tight seal of MD 200.

In some cases, MD 200 can be implantable cardiac pacemaker (ICP).In this example, MD 200 can be with With one or more leads (such as lead 212), it is implanted on the heart of patient or in the heart of patient.One or more A lead 212 may include one or more electrodes 214 with the heart tissue of patient's heart and/or contacting blood.MD 200 Can be configured as the electrocardiosignal that inherently generates of sensing, and determined based on the analysis of the signal sensed such as one or Multiple arrhythmia cordis.MD 200 can be configured as the lead 212 via being implanted in heart deliver CRT, ATP treatment, Bradycardia treatment and/or other treatment type.In some instances, MD 200 can be additionally configured to provide defibrillation and control It treats.

In some cases, MD 200 can be implantable cardiac cardioverter defibrillators (ICD).In such an example, MD 200 may include the one or more leads being implanted in patient's heart.MD 200 can be additionally configured to sensing electrocardio letter Number, the generation of tachyarrhythmia is determined based on the signal sensed, and can be configured as in response to determining quickly The generation of property arrhythmia cordis and deliver defibrillation therapy.In other examples, MD 200 can be subcutaneous implantable cardiac conversion and remove Quiver device (S-ICD).In the example that MD 200 is S-ICD, one in lead 212 can be the lead being subcutaneously implanted.In MD 200 be at least some examples of S-ICD, and MD 200 can only include the single lead being subcutaneously implanted, but this is not required 's.In some cases, one or more leads can have one or more electrodes, and the electrode is hypodermically placed and position In the outside in thoracic cavity.In other examples, one or more leads can have one or more electrodes, and the electrode is placed In the inside in thoracic cavity, such as just in the inside of breastbone but in the outside of heart H.

In some instances, MD 200 can not be implantable medical device.On the contrary, MD 200 can be outside patient body The equipment in portion, and may include the skin electrode being placed on a patient body.In such an example, MD 200 can energy Enough sense surface electric signal (for example, by heart generate electrocardiosignal or the equipment by being implanted in patient body generate and The electric signal of skin is transmitted to by body).In such an example, MD 200 can be configured as the various types of electricity of delivering Stimulation therapy, for example including defibrillation therapy.

Fig. 9 shows the example of medical apparatus system and communication path, multiple Medical Devices 302,304,306 and/or 310 It can be communicated by the communication path.In the example shown, medical apparatus system 300 may include: 302 He of LCP 304, external medical equipment 306 and other sensors/equipment 310.External equipment 306 can be previously described about MD's 200 Any of equipment.Other sensors/equipment 310 is also possible to previously described any of the equipment about MD 200. In some cases, other sensors/equipment 310 may include sensor, such as accelerometer, acoustic sensor or blood pressure Sensor etc..In some cases, other sensors/equipment 310 may include the one or more that can be used for system 300 The external programmer equipment that equipment is programmed.

The various equipment of system 300 can be communicated via communication path 308.Communication path 308 may include one Or multiple and different communication paths and/or multiple and different communication patterns.Communication path 308 can also be including one or more not Same communication vector.In some cases, for example, LCP 302 and/or 304 can sense intrinsic electrocardiosignal, and can be through Such signal is transmitted to one or more other equipment 302/304,306 and 310 of system 300 by communication path 308.? In one example, one or more of equipment 302/304 can receive such signal, and based on the signal received come Determine the generation of arrhythmia cordis.In some cases, such determination can be transmitted to by one or more equipment 302/304 is One or more other equipment 306 and 310 of system 300.In some cases, the equipment 302/304,306 and 310 of system 300 One or more of can be taken action based on the determination of the arrhythmia cordis transmitted (such as by being passed to the heart of patient Send electro photoluminescence appropriate).It is contemplated that RF signal, induction type coupling, optical signalling, acoustics letter can be used in communication path 308 Number or any other signal suitable for communication communicated.In addition, at least some examples, equipment communication path 308 can be with Including multiple signal types.For example, other sensors/equipment 310 can be used the first signal type (for example, RF communicate) with it is outer Portion's equipment 306 communicates, and is communicated using second signal type (for example, conduction-type communication) with LCP 302/304.Further, It in some instances, can be with the communication between limiting device.For example, as described above, in some instances, LCP 302/304 can It is communicated with only passing through other sensors/equipment 310 with external equipment 306, wherein LCP 302/304 transmits a signal to other sensings Device/equipment 310, and the signal received is forwarded to external equipment 306 by other sensors/equipment 310.

In some cases, communication path 308 may include conduction-type communication.Therefore, the equipment of system 300 can have Allow the component of this conduction-type communication.For example, the equipment of system 300 can be configured as one or more via sending device A electrode transmission conduction-type signal of communication (for example, electric current and/or voltage pulse), and can be via connecing into the body of patient One or more electrodes of receiving unit receive conduction-type signal of communication (for example, pulse).The body of patient can be by conduction-type Signal of communication (such as pulse) is from one or more electrodes " conduction " of sending device to the electricity of the receiving device in system 300 Pole.In such an example, the conduction-type signal of communication (for example, pulse) delivered can with pace-making or other treatment signal not Together.For example, the equipment of system 300 can deliver telecommunication arteries and veins using amplitude/pulse width of the son capture threshold value as heart Punching.Although in some cases, amplitude/pulse width of the telecommunication pulse of delivering could possibly be higher than the capture threshold value of heart, It is that can be delivered and/or can be incorporated in during the blanking interval (blanking period) (such as refractory period) of heart In pacemaker impulse or it is modulated on pacemaker impulse (if necessary).

The telecommunication pulse of delivering can be modulated in any suitable manner to encode to the information transmitted.One In a little situations, communication pulse can be the either pulse amplitude modulation of pulse width modulation.It alternatively or additionally, can To modulate the time between pulse to encode to desired information.In some cases, conduction-type communication pulse according to Need can be voltage pulse, current impulse, two-phase voltage pulse, biphasic current pulse or any other suitable electric pulse.

Figure 10 shows illustrative medical apparatus system.In Figure 10, LCP 402 is shown as fixed to heart 410 The inside of left ventricle, and impulse generator 406 is illustrated as coupled to the lead with one or more electrode 408a-408c 412.In some cases, impulse generator 406 can be a part of subcutaneous implantable cardiac cardioverter defibrillators (S-ICD), And one or more electrode 408a-408c can be positioned hypodermically.In some cases, one or more electrode 408a- 408c can be placed on thoracic cavity but the outside in heart, such as just in the inside of breastbone.In some cases, LCP 402 can communicate with subcutaneous implantable cardiac cardioverter defibrillators (S-ICD).In some cases, lead 412 and/or pulse hair Raw device 406 may include accelerometer 414, and can for example be configured as sensing can indicate the vibration of heart sound.

In some cases, as needed, LCP 402 can be in the right ventricle of heart, atrium dextrum, left ventricle or atrium sinistrum In.In some cases, more than one LCP 402 can be implanted into.For example, a LCP can be implanted in right ventricle, and Another can be implanted in atrium dextrum.In another example, a LCP can be implanted in right ventricle, and another It is a to be implanted in left ventricle.In another example again, a LCP can be implanted in each of chamber of heart.

Figure 11 and Figure 12 provides the predictive example for the possible communication link quality value being added on Fig. 2.In Figure 11 In example shown in Figure 12, communication link quality value is indicated according to link margin.It is higher compared to lower link margin Link margin indicate high quality communication link.Although link margin is used in this example, but it is envisioned that be that can make With estimating for any suitable communication link quality, including such as signal-to-noise ratio, transmission speed, signal impedance, power consumption and/or any Other suitable link quality values are estimated.

Although these predictive examples show the system of such as system 20, system 20 include HUB 22 and SAT24,26, 28, it is to be understood that this is merely illustrative, and the system that will also apply to all systems as shown in Figure 1 10. These predictive examples will also apply to the system with greater number of autonomous device or the system with less autonomous device. Figure 11 provides the example that wherein patient is the predictive data for system of heart rate upright and with 80bpm, and It is the similar data for system lie on the back and the heart rate with 60bpm that Figure 12, which provides wherein patient,.Following table 1 mentions The information for having supplied the remaining battery power about each equipment is all identical for Figure 11 and Figure 12:

Table 1

Such as by checking the Link Margin value of Figure 11 record it can be noted that some communication paths may be considered that than other Communication path is more preferable.Figure 11 also shows link margin and therefore which equipment is the quality of communication path can depend on It carries out transmission and which equipment is being received.For example, checking that the expression of a HUB 22 is positive carries out transmission and SAT ONE 24 indicate to be positive to carry out received communication path 22a, and link margin is represented as 10 decibels (dB).However, SAT ONE 24 Expression, which is positive, to be carried out transmission and is positive the expression of HUB 22 to carry out received communication path 24a, and link margin is represented as 5dB. It is still successful communication path (being likely to), but in some cases, the direction of transmission may influence link margin.

Only check and be transferred to HUB 22 in each of SAT 24,26,28, it can be seen that be that HUB 22 has to SAT The strong communication path 22a (10dB link margin, as described above) of ONE 24, and therefore can be directly logical with SAT ONE 24 Letter.This is represented as H-1 in following table 2, wherein " H " indicates Hub 22, and " 1 " indicates SAT ONE 24.Maincenter 22 With the strong communication path 22c (link margin with 20dB) to SAT TWO 26, and therefore can be with SAT TWO 26 Direct communication.This is represented as H-2 in following table 2, wherein " 2 " indicate SAT TWO 26.However, in the example shown, HUB 22 is with the poor direct communication path 22b (link margin with only 2dB) to SAT THREE 28.Note that HUB 22 have to SAT TWO 26 good communication path 22c (for example, 20dB link margin), and SAT TWO 26 have arrive The good communication path 26b (such as 5dB link margin) of SAT THREE 28.In this way, HUB 22 can be directed toward via passing through It communicates message with SAT THREE 28 by the indirect communication path of SAT TWO 26, is represented as in table 2 Ru following H-2-3, wherein " 2 " indicate SAT TWO 26 and " 3 " indicate SAT THREE 28.Other communication paths can shown in table 2 To be shown in the similar mode about the Link Margin value indicated in Figure 11.

Table 2

The case where Figure 12 is similar to Figure 11, but to show patient now be heart rate that is lying on the back and having 60bpm Predictive data.As it can be seen, for the communication path between each of HUB 22 and SAT 24,26,28 Link margin can be in different when stand up position from patient as shown in figure 11.Use illustrative link margin shown in Figure 12 Data, the example optimal communication path between each of HUB 22 and SAT 24,26,28 can be as summarized in the following table 3.

Table 3

In some cases, it can be possible to it is expected that balancing equipment service life (being indicated by remaining battery power) and message route.For example, If SAT 24,26,28 can be communicated with one another with low power mode, but the communicating requirement between HUB 22 and SAT 24,26,28 Higher power, then the satellite equipment with maximum residual service life (battery capacity) can be designated as passing through in some cases It routes the equipment of all message between 24,26,28 and HUB of SAT 22.In the example shown, SAT THREE 28 has Have highest remaining battery power (referring to table 1), and therefore as long as possible SAT THREE 28 be then used as SAT 24, 26, the trunking between 28 and HUB 22.When condition prevents SAT THREE 28 from communicating with HUB 22, can be used Satellite equipment with next highest surplus equipment service life, such as SAT TWO 26.

In some cases, some message may the response time more faster than other message calls.For example, in atrium dextrum LCP can send message to the LCP of right ventricle with every heartbeat, indicate the generation of atrial contraction, so that LCP in right ventricle can be with Make right ventricular pacing in response to atrial contraction (CRT).The message may require the relatively fast response time suitably to assist Adjust delivered treatment.May need another example message compared with fast-response time may include triggering disappearing for life-sustaining therapy Breath, arrhythmia detection etc..LCP in atrium dextrum can also send message to SICD equipment, periodically by non-pass Key data uploads to SICD.The response time that this message may not seek quickness.In this example, the LCP in atrium dextrum can be with Selection meets the different communication path of the desired response time for each type of message, while still meeting link margin It is required that and in some cases, while making to minimize the power demand of all or certain equipment.

In some cases, when the access of multiple satellite equipments should periodically be uploaded to the identical information of HUB 22 When, it may be desirable to balance service life (battery capacity).The example of such information includes but is not limited to posture, core temperature and heart sound Amplitude.Since which device request data HUB 22 can choose from, HUB 22 in some cases can be from being visited Ask have in those of data equipment the maximum residual service life device request it.HUB 22 can maintain HUB 22 that will ask from it The priority list of data is sought, and in the above example, priority list will be followed successively by SAT THREE 28, SAT TWO 26 followed by SAT ONE 24, because this corresponds to the relative surplus battery life of each satellite.Alternatively or additionally, In some cases, HUB 22 can be from the device request data with lower communication overhead (for example, highest link margin).? Under some cases, when link margin is relatively high, it is possible to reduce for the power level of data transmission, opened to reduce communication Pin.

In some cases, it can be possible to it is expected to optimize power consumption.With reference to the predictive data shown in Figure 11, it is assumed that expectation HUB 22 is communicated with SAT THREE 28.HUB 22 and SAT 24,26,28 is considered to be configured to adjust and be used for The power level of data transmission and data receiver.Although direct link may be THREE 28 from HUB 22 to SAT, Communication path 22b has low link margin, possibly forces transimission power (by HUB 22) and reception power (passing through SAT THREE 28) it is set to peak power setting.However, since HUB 22 has the good communication path to SAT TWO 26 22c (such as 20dB link margin), and SAT TWO 26 has the good communication path 26b (example to SAT THREE 28 Such as 5dB link margin), therefore HUB 22 can potentially be used by transmitting message by SAT TWO 26 with comparing Direct link carries out communicating the lower total power consumption of required power consumption, to be communicated with SAT THREE 28.

It should be understood that the disclosure is merely illustrative in many aspects.Without departing from the scope of the present disclosure the case where Under, the change in details, particularly in terms of the arrangement of shape, size and step can be carried out.In degree appropriate, this can With include an example embodiment used in other embodiments any feature use.

Claims

1. a kind of implantable medical device (IMD) is configured as at least two other implantable medicals in the patient with implantation Equipment (IMD) communication, the IMD include:

Shell；

Telecommunication circuit；

It is operatively coupled to the controller of the telecommunication circuit, the controller is configured as:

Be based at least partially on multiple communication link quality values select for in other IMD selected by an IMD led to The communication path and/or communication pattern of letter, the multiple communication link quality value and can be used in and the institute in other IMD Select multiple communication paths and/or multiple communication patterns of an IMD communication associated；And

Described selected one in selected communication path and/or communication pattern and other IMD is used via the telecommunication circuit A IMD is communicated.

2. IMD according to claim 1, wherein the controller is also based at least partially on one or more sensors Input is to select the communication path and/or the communication pattern.

3. IMD according to claim 2, wherein one or more of sensor inputs include one or more physiology Input.

4. IMD according to claim 3, wherein one or more of physiology inputs include impedance input, posture input With heart rate input one or more of.

5. IMD according to claim 2, wherein one or more of sensor inputs include battery life sensor Input.

6. IMD according to any one of claim 1 to 5, in which:

The controller is also based at least partially on by each in the multiple communication path and/or the multiple communication pattern Power consumption consumed by a selects the communication path and/or the communication pattern；And/or

The controller is also based at least partially on each of the multiple communication path and/or the multiple communication pattern Data transfer rate select the communication path and/or the communication pattern.

7. IMD according to any one of claim 1 to 6, wherein if the multiple communication link quality value is at any time Variation, then the controller selects new communication path and/or communication pattern.

8. IMD according to any one of claim 1 to 7, wherein described more when there are more than one communication path A communication path includes two or more communication paths using different vectors.

9. IMD according to any one of claim 1 to 8, wherein described more when there are more than one communication pattern A communication pattern includes two or more in conduction-type communication, induction type communication, RF communication, acoustic communication and optical communication It is a.

10. IMD according to any one of claim 1 to 9, wherein the IMD is maincenter, and described at least two Other implantable medical devices (IMD) are the satellites of the maincenter.

11. IMD according to claim 10, wherein the IMD is configured as via the telecommunication circuit and patient-external One or more non-implantable devices communication.

12. a kind of implantable medical device (IMD) is configured as at least one other implantable medical in the patient with implantation Equipment (IMD) communication, the IMD include:

Shell；

It is exposed on three or more electrodes of the outside of the shell；

It is operatively coupled to the telecommunication circuit of three or more electrodes；

It is operatively coupled to the controller of the telecommunication circuit, the controller is configured that

When the first conduction-type communication vector of a pair of electrodes corresponded in three or more described electrodes provides and institute The communication link of first IMD at least one other implantable medical device (IMD) is stated, the communication link is best full Foot predetermined link quality criteria when, via the telecommunication circuit using first conduction-type communication vector and it is described at least one First IMD in other IMD is communicated；And

When the second conduction-type communication vector of the second pair of electrode corresponded in three or more described electrodes provides and institute The communication link of first IMD at least one other IMD is stated, the communication link best meets the predetermined link matter When amount standard, used in second conduction-type communication vector and at least one other IMD via the telecommunication circuit First IMD is communicated.

13. IMD according to claim 12, wherein the IMD be configured as with implantation in the patient at least two its He communicates implantable medical device (IMD), and wherein, the controller is configured as, even if when the controller will use When the first conduction-type communication vector is communicated with first IMD in other IMD, also use and first conduction-type The different conduction-type communication vector of communication vector is communicated with second IMD in described at least two other IMD.

14. IMD according to claim 13, wherein the controller is configured as assessing which communication vector repeatedly most Meet the predetermined link quality criteria well.

15. a kind of implantable medical device (IMD) is configured as and is implanted at least two other implantable doctors in the patient Equipment (IMD) communication is treated, the IMD includes:

Shell；

Telecommunication circuit；

Broadcast message is received during the first broadcast window；

Determine whether the broadcast message is addressed to the IMD；

The second broadcast window in response to finding that the broadcast message is addressed to the IMD, after first broadcast window Broadcast acknowledgements message during mouthful；

In response to finding that the broadcast message is not addressed to the IMD, determine another IMD whether in second broadcast window Period broadcast acknowledgements message, and

In response to finding another IMD broadcast acknowledgements during second broadcast window, after second broadcast window The broadcast message is not replayed during third broadcast window；And

In response to finding another IMD not broadcast acknowledgements during second broadcast window, after second broadcast window Third broadcast window during replay the broadcast message.